重症肺炎患者血清IL-18、IL-23、IL-33与肠道菌群和临床转归的关系分析

摘要 目的：研究重症肺炎（SP）患者血清白细胞介素-18（IL-18）、白细胞介素-23（IL-23）、白细胞介素-33（IL-33）与肠道菌群和临床转归的关系。方法：选取2019年12月～2022年6月济南市人民医院收治的90例SP患者，记作研究组。另取同期收治的90例普通肺炎患者作为对照组。对比两组血清IL-18、IL-23、IL-33与肠道菌群含量，并以Pearson相关性分析两者的关系。此外，将研究组患者按照治疗后临床转归情况的差异分为好转组60例及恶化组30例，多因素Logistic回归分析SP患者临床转归的影响因素。结果：研究组血清IL-18、IL-23、IL-33水平高于对照组（均P＜0.05）。研究组大肠埃希菌、肠球菌含量均高于对照组，而拟杆菌、双歧杆菌及乳酸杆菌含量均低于对照组（均P＜0.05）。经Pearson相关性分析可得：血清IL-18、IL-23、IL-33与大肠埃希菌、肠球菌含量呈正相关关系，而与拟杆菌、双歧杆菌及乳酸杆菌含量呈负相关关系（均P＜0.05）。好转组年龄及血清IL-18、IL-23、IL-33水平均低于恶化组，且机械通气与长期卧床人数占比均低于恶化组（均P＜0.05）。经多因素Logistic回归分析发现：年龄大、机械通气、长期卧床以及血清IL-18、IL-23、IL-33水平高均是SP患者治疗后恶化的危险因素（均P＜0.05）。结论：SP患者血清IL-18、IL-23、IL-33与肠道菌群密切相关，且随着上述三项血清指标水平的升高，患者临床转归越差。

Analysis of the Relationship between Serum IL-18, IL-23, IL-33 and Intestinal Flora and Clinical Outcom in Patients with Severe Pneumonia

ABSTRACT Objective: To analyze the relationship between serum interleukin-18 (IL-18), interleukin-23 (IL-23), Interleukin-33 (IL-33) and intestinal flora and clinical outcome in patients with severe pneumonia (SP). Methods: 90 patients with SP who were admitted to Jinan People''s Hospital from December 2019 to June 2022 were selected as the study group.Another 90 patients with common pneumonia who were admitted in the same period were taken as the control group.The serum IL-18, IL-23, IL-33 and intestinal microflora in the two groups were compared, and the relationship between them was analyzed by Pearson correlation. In addition, the patients in the study group were divided into improvement group with 60 cases and deterioration group with 30 cases according to the difference of clinical outcome after treatment.The influencing factors of clinical outcome of patients with SP were analyzed by multivariate Logistic regression. Results: The levels of serum IL-18, IL-23 and IL-33 in the study group were higher than those in the control group (all P<0.05). The contents of Escherichia coli and Enterococcus in the study group were higher than those in the control group, while the contents of Bacteroides, Bifidobacterium and Lactobacillus were lower than those in the control group (all P<0.05). Pearson correlation analysis showed that serum IL-18, IL-23 and IL-33 were positively correlated with the contents of Escherichia coli and Enterococcus, but negatively correlated with the contents of Bacteroides, Bifidobacterium and Lactobacillus (all P<0.05). The age and the levels of serum IL-18, IL-23 and IL-33 in the improvement group were lower than those in the deterioration group, and the proportion of mechanical ventilation and long-term bed rest were lower than those in the deterioration group (all P<0.05). Multivariate Logistic regression analysis showed that older age, mechanical ventilation, long-term bed rest and high levels of serum IL-18, IL-23 and IL-33 were risk factors for the deterioration of patients with SP after treatment (all P<0.05). Conclusion: Serum IL-18, IL-23 and IL-33 of patients with SP are closely related to intestinal flora, and with the increase of the above three serum indicators, the clinical outcome of patients is worse.